This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Tuesday, 18 January 2011

Another article on Hospital care.

Should we bother writing to this woman and explaining how unrealistic her expectations were and how greatly she misunderstood the situation? She is right about hospital care. But yet she completely misinterpreted the situation.

Do you think she actually wants to know and understand or do you think she just wants to moan?

As I work in medicine at a district general hospital I know how long it takes to get new patients sorted. I know how difficult it is to do the right thing with elderly people and how slow the system is to act. But I think this woman just has it in for the frontline professionals. She lacks insight and sense and takes it out on the Nurses and Doctors rather than the shitty system they work in.

The GP had been called to the residential care home in which she lives – Sylvia has severe dementia – because she had not been eating or, more importantly, drinking for 24 hours and was virtually comatose. The GP diagnosed possible pneumonia and asked that Sylvia should be put on a re-hydration and anti-biotic drip within two hours

The GP had to know that there was no way that she could be admitted and started on those orders within two hours. He must have been covering his ass. Tests have to be done in hospital and the hospital consultant has to see the patient in AAU long before anything can be started. A lot of ducks have to be line up in a row for a diagnosis to happen and the right treatment to be initiated.

Unfortunately, no assessing of Sylvia’s condition was carried out for several hours. I understand that recent policy in the NHS requires patients to be held for no longer than 4 hours in Casualty. Clearly, this does not apply to the “assessment” ward.

That is of course why they have assessment wards (AAU). There are not enough beds, staff (the right kind of staff) or facilities to meet the targets and avoid the hospital getting fined. Management did this.

After waiting three hours, I approached a female nurse and explained about the GP’s wishes. Standing under a poster warning patients and their families not to abuse hospital staff, the nurse sarcastically answered me. “With all due respect, darling, it is for the hospital doctor to decide on diagnosis and treatment not the GP.”

That is 100% true. No hospital Nurse or hospital doctor can act on orders by a GP. The GP did not make a definite diagnosis. He did not have the diagnostic tests at his disposal to do that. It would hurt patients even more if the hospital staff did what this author believed that they should do. Hanging the wrong IV fluids or IV antibiotics could kill a patient very fast and a doctor's rule is "first do no harm". The Nurse of course can NOT hang IV fluids or IV antibiotics until the consultant has seen the patient and one of his doctors has prescribed the darn things. These places are so short of qualified staff (not unqualified staff ....lots of them hanging around) that I think they did well to get it sorted within 24 hours.

Eventually a doctor appeared. He was perfectly polite and, after examining Sylvia, took us to one side, explained that there were “quite a few things going on with Sylvia” and asked for our decision on resuscitation. Not having realised Sylvia’s condition was that serious, we were very shocked – not least because she had been left untreated

That is a bit silly. An elderly woman with severe dementia who has stopped eating and drinking could be at death's door regardless of pneumonia, IV fluids and IV antibiotics. Those treatments might have worked or they might have sent another organ system in her body totally screwy. Doctors are clinicians not psychic mediums. Medicine is not a cut and dried science that always follows a logical planned and steady algorithm. I bet her renal function was also a mess. Anyone (me, you, etc) could drop over dead at any time. An elderly person who is sick enough to get admitted to hospital is very likely to just crash at anytime regardless of anything the doctors and nurses are or are not doing.

He was correct to ask about rescus status. At this point there was no way for the medic to know how things would turn out for Sylvia. I once worked with a young healthy nurse who fell over and died of a stroke in the middle of the shift. If that can happen to her it can happen to an elderly lady at anytime, regardless of IV antibiotics and fluids.

The whereabouts of the consultant was a mystery. Neither he nor his team were in attendance, despite the fact that there were two other elderly ladies with chronic dementia on the ward.

Believe me when I tell you that this consultant would have had over a 100 patients with confusion, dementia and multiple other medical problems on many, many, different wards all over the hospital. It takes these guys something like 10 hours in a day to see all of these people just one time. Plus they have clinics and everything else. It is offensive for you to imply that he was bunking off and ignoring his patients. If you tried to keep pace with his work day just once you would collapse.

Next morning I rang again – quite prepared for Sylvia to have died in the night – to be told that she was absolutely fine and could go home.

This is how it is with elderly people who have dementia. It is never cut and dried and you don't know what will happen. If they sent her home the next day it is highly unlikely that she had pneumonia, as the GP led you to believe. Older people with dementia often stop eating and drinking and have alterations in levels of consciousness. It may be an acute medical problem that needs IVs and other treatments or it may just be the kind of quick deterioration that happens to all older people as their bodies start to shut down. They often seem to rally, then get worse, then rally again. Not eating and drinking etc is normal for people when they get to end stage of life. And all elderly people are at the end stage of life and their bodies are going haywire and shutting down. Fixing one problem causes another to start. If some IV fluids helped her come around this time then that is great. But it doesn't mean that she is "cured".

Pleased though we were, we wanted an explanation. Nothing tallied.

She is elderly. And elderly patients are complicated. There is no cure for old age. She was admitted to hospital. They did some tests. She came around and they determined that she was medically stable and they sent her home.

There is nothing else to tell. You are wanting instant answers and diagnostics and a cut and dried plan of care instantly. This is impossible in general medicine especially with elderly patients. In other words, nothing tallies because you have no experience or education in health care. If the hospital doctor and nurses explained this to you as I am explaining it to you would not have liked it.

However, Sylvia was not sent home that day because she became unwell again.

Yep. Elderly patients go up and down like this because they are at the end of their lives. Doctors are brilliant but there are two things that they cannot do. They cannot cure old age or stop us from being mortals with bodies that give out.

I would imagine that she will deteriorate, rally, deteriorate, rally, deteriorate, rally many more times before she passes. All without a concrete diagnosis. That is normal. It is no different for elderly people in the United States, Canada, Australia etc.

I have numerous questions including – was Sylvia apparently ignored? Why is there no communication between the GP and the ward staff – and is this nurse’s opinion, of the GP’s ability to diagnose, commonly found in NHS wards?

It wasn't the Nurse's opinion. The Nurse was telling you a fact. A fact that should be obvious. Even if the GP had wrote out orders (which he did not) and faxed them the Hospital nurse still would NOT have been able to act on them. The hospital doctor has to write the orders. The GP did not have the information to give safe orders. A doctor cannot prescribe IVs etc without blood tests and xrays. The hospital doctor will prescribe what needs to be prescribed when he has all of his ducks in a row. If Nurses are to give IV fluids or IV antbiotics the order has to be written on a hospital drug chart by hospital doctors. Otherwise it is an illegal order and cannot be given. Sylvia was not ignored. She was under the care of Nurses and Doctors who were already 4-5 hours behind on doing what needed to be done for the patients that they already had when Sylvia came through the door.

Why was there no polite, informed communication between the ward staff and me – I was not the only person sitting beside an elderly relative’s bed, not knowing what to do?

Did it very occur to you that:

A. An RN cannot delay treatment for the 15 people she is responsible for to chat with relatives
B. The five unqualifed staff sitting at the Nurse's station cannot help me implement doctors orders or communicate with relatives. A Nurse has to handle that all by herself all at the same time. And there is only one Nurse for a large team of patients despite how many techs you see hanging around.
C..That there was nothing to tell? It gets very frustrating when relatives sit around with nothing to do obsessing over every little detail and inventing these paranoid scenarios where everyone is trying to neglect and kill grandma and hide information from them. Open your eyes a little.

there was no evidence of shortness of staff; indeed a lot of eating and chatting was going on at the nurses’ station.

From what I hear, Shitborough has some of the worst direct RN to patient ratios in the galaxy. It is lack of RN's that are the problem, not lack of techs and unqualified staff.
You know not what you see. I know how wards are staffed in these places. Many of the staff you see at the station are not Nurses and Doctors. They are care assistants and techs. And even if I had a hundred of them working with me I would still be too short of nurses and doctors to get things done in a timely fashion. I once had a bag of IV fluids run out on a patient and it took me 5 hours to chase down a doctor to get him to prescribe more so that I could hang a new bag A few techs sat at the nurse's station drinking tea and chatting does not change how long it takes the doctor to get results of diagnostic tests so that he can order the correct treatment. I could have a thousand techs working with me on a shift. But whether they look busy or are sitting around at the station does not change how long it takes to get orders written by the doctor and implemented by the Nurse.

I think you are either very unrealistic or are simply shit stirring. And please keep in mind that no hospital Nurse can act on orders or start any kind of IV therapy unless it has been prescribed onto the hospital system by the hospital doctors. Not under any circumstances ever.

I am also surprised that a medic told her that someone would ring from the ward with an update! As a ward Nurse I am almost never in a position when I can abandon those IV fluids and meds that I am hours and hours behind on starting on all those people to call relatives. The only help I have are techs and assistants and they cannot make calls to relatives NOR can they continue with my workload as I am sat around ringing the relatives of 15 different people to give an "update".

Way off base is correct.People want to think that their elderly rel will live forever. Or that they will die peacefully in their sleep. Unfortunately this rarely happens-and it would be a brave GP who would have suggested leaving Sylvia in the care home (or put in a drip himself). Most other EU countries do not have the equivalent of "care homes" without qualified RNs. Maybe this is the real issue here.Having skimmed through the comments below her article, all I can say is that the tories of this country will soon be getting what they think they want- a fully private system...competition and no holds barred asset stripping by the private sector will strip the NHS bare. If you are fit and have a bit of money then you will get a bed in a private hospital for your elective whatever. If you are like Sylvia then you will still fester on an admissions unit or a medical ward- the difference will be no RNs and even less chance to see a consultant. all I can say is it will serve the great british public right.

I think its just innocent/ignorant public expectations isnt it. They have no idea of the realities of the NHS at all.

I used to work on an Assessment/Admission unit, and it was so frustrating...the elderly lady in question was lucky to even get into a bed on arrival, because where I worked she would have been on the ambulance stretcher in the corridor/across nurse-base/ inside a bay/alongside the crash trolly etc etc delete as appropriate..... for 2-3 hours before even getting a bed.

Then she would have waited 6+ hours to see a doctor...

The NHS SYSTEM is a joke...and people like Mrs Potts just presume its down to poor nursing and medical standards...

Ah yes, the great tory problem. They cannot conceive of a world where simply blaming the workers will no longer fix things. How dare they want to be able to have a decent standard of living or a safe working environment, for shame! Send them back down the mines or into the mills...All tory solutions begin with the ridiculous idea that competition is the way to drive up standards and at the same time reduce costs. Might work for robots on a production line but not when caring for sick people, I'm afraid... The world of the "free market" in healthcare is exactly what we are getting, you load of ignorant so and sos. Ask yourself this- if you were a private healthcare provider, who would you rather care for....easy, fit patients who do as they are told, get better and leave on time? Or elderly demented patients who are demanding, timecomsuming and costly, need loads of external input by social services and block all your nice tidy beds? Not to mention all those ungrateful people with chronic problems...afterall, they brought it on themselves, didn't they, with their smoking and drinking and bad diets and poor hygiene? This is real face of politics today...and NuLabour would be no better.

Cock your head to the side, look at them intently and say "Well the doctor has lots of patients all over the hospital with many things going on. I doubt he even knows when he will be here".Then giggle a bit.

I have told family members that we don't have GPS tracking devices on the doctors. But they were old neighbours of mine so I could tease them a bit and be a bit saucy.

I work in an admissions unit. Patients are *normally* seen within 4 hours. But that isn't enough; the relatives want them seen AS SOON as they get there, because the GP has told them that the bed will be waiting and that the doctor will be ready for them. Admissions units are hell on earth. At least ours have a 1:8 ratio, most of the time.

The old style matrons would take one look around the place and see how bad the RN staffing levels are and how badly resourced the wards are also. Old Matron would see how useless most of the lowly paid cheap labour that have replaced qualified Nurses is and how disrespectful they are to the Nurses and doctors.

Old Matron would see crazy visitors with unrealistic expectations running around stopping anyone from getting any work done.

And the first thing that old style matron would do is beat the living fucking shit out of the managers. She would demand a return to functional wards. She would mop the Nurses's brows and tell them it will be okay. And then she would beat the living shit out of the managers again. She would drag the rude, selfish, and overbearing visitors out by their earlobes when they interfered in another patient's care to get their own and less ill relative seen to first.

Until you have qualified and walked the walk on a short staffed ward you are completely unable to comprehend what we are talking about on here or understand where we are coming from. To someone like you, we must sound like we are coming out of left field having a moan.

and I don't see teachers and social workers working 14 hour days without a break and then having to stay over another two hours unpaid in addition to that to finish off things that they are legally accountable for or face possible loss of registration and criminal prosecution.

There are those of us that understand but are not qualified Anne. Thats why I am praying to God for a Theatre or Surgical post and will be doing my best to avoid Medical...if I can find a job at all that is.

From what I can see I will need at least 2 years experience at this end before I can apply abroad. Then I am liking the sound of Canada.

Louise, this is a nurses blog. So it is about the current state of nursing. Which happens to be crappy and looking to be getting worse. So of course the posts on here are not about fluffy bunnies and kittens. But having a place to vent like on here is better than having a full on melt down on the ward.

Though I have a friend who is a staff nurse in medical up here in Scotland and for the time being our lot seems much better than down south. Long may it continue. But with the new proposal to give newly qualified nurses an apprenticeship rather than an actual job we will see how things go.

I would like to point out that not all healthcare assistants that work on hospital wards are uneducated or disrespectful towards nurses or doctors. I have done my training but due to unavoidable life issues in my final year i didn't qualify.

I work hard in my job role and I help my nurse collegues as much as i can, to be honest i wish i could do more. On the acute unit where i work we are a team, just because we are 'only' healthcare assistants does not make us any less valuable than nurses, we undertake training to do what we do and we have to understand the rationale behind what we do, so please stop bashing on the healthcare assistants and realise we are not the enemy people like the wonderful Mrs. Potts are the ones who like to stir up shit and make all healthcare staffs life hell no matter what level we are.

P.S. and sad as it may seem to all you nurses who are disillusioned given the oportunity i would gladly redo my training but those life issues that stopped me before are still present so for now i have to be a lowly healthcare assitant :(.

Anne has pointed out in plenty of her posts that she has worked with fantastic care assistants in her time. But the new cadets being brought in are pretty useless, and they are replacing the good assistants.

I have also worked with wonderful care assistants but others who are just there to pick up a pay check.As an assistant yourself you must understand that the nurses have responsibility for your work. They are held responsible if you mess up. Its good that you take your job seriously but even you must accept that there are others out there who do not.

I am a care assistant and student nurse myself btw. I am not just another nurse slating care assistants. But I have worked with people that dont give a damn. Disappear off the ward when they want too. Bad mouth the nurses to patients and relatives. And you wonder why nurses get angry?

Oh and Anonymous I don't think that healthcare assistants are lowly. If I was staying in this country I would turn in my registration and become a health care assistant. Being an RN in the NHS is dangerous.

May you never again be in the position of having to answer the phones, placate the selfish cunt relatives, mix up 14 IV drugs, clean up the patient who just shat himself, check the obs, pick up the dementia patient from the floor, start an IVI. do the frickin drug round, start a blood transfusion AND cannulate a dehydrated 90 year old EVER again.

I have to stop you there Anne, I know alot of social workers, particually in child protective services who put in way more hours and work incredibly unsocial and long hours, the difference however is that they get paid reasonably well for it, or at least that SEEMS to be the case. One of my senior lecturers back in college did shifts during holidays as a Social Worker and she got paid a shit ton for it. It was like agency work but 10x better paid.

You do your training, paid for by the NHS, take a bursary for three years, also paid for by the NHS, get your qualification and registration, work in the NHS for relatively 5 mins to have some experience to put on your CV and then you fuck off abroad. And you wonder why the NHS is in the mess its in. No wonder with so many dedicated nurses like yourself.........

Most workers in this country need and would like decent working conditions and a bit of respect. Grow up and join the real world. No one is making you be a nurse. If you hate it that much then leave. I shudder to think of my loved ones being 'cared for' by people with attitudes like yours.

Excuse me Anonmymous but I trained abroad at a large and well respected University in the Midwest (USA).

I paid for my own damn education by working 3 jobs whilst going to school I also paid for the degree I have prior to Nursing OUT OF MY OWN POCKET. Your eyes would water if I told told you how much I paid to go to school over there.

Nurses are fucking off abroad because in the NHS they are forced to care for too many patients at once. This is down to hospital trusts intentionally short staffing the wards because they don't want to pay for RNs.

When A Nurse is forced to care for too many patients she cannot give anything even approaching good care. And the patients and relatives get very abusive.

In Australia and certain parts of the USA there are Nurse to Patient ratio laws that protect Nurses from this rubbish. Canada is following suit. That is why so many British Nurses are heading abroad.

"Grow up and join the real world. No one is making you be a nurse. If you hate it that much then leave. I shudder to think of my loved ones being 'cared for' by people with attitudes like yours."

People seem to think nursing is a vocation and that we will do the job regardless of pay, that the Sun's image of angels caring for the sick and dying is enough payment for what we do. I have spent the last three years living in poverty, whilst working as an unpaid slave on the wards (supernumary only in name) and having to burn myself out from working extra shifts on the bank as a hca just so that I can eat. I still go in to work because I love nursing, I give a shit about my patients, but attitudes from the public that we should just "put up or shut up" really do not help matters. I'm close to jacking in because at the moment I have to decide between paying my rent or paying for some food to last the month and a travelcard to get into placement, I have 3 months to go on my course, but cannot see myself affording to live anymore on the wonderful bursary I should be so grateful for. I resent being told to grow up and join the real world, because at the moment I'm drowning in it.

Your comment is dumb, Claire. First of all we are leaving for better nurse to patient ratios not profit. Secondly I and my colleagues have been fighting and trying to change things for years. We have filled in literally thousands of incident forms up and down the nation. We have written politicians and managers over and over again. We have submittedpetitions loaded with signatures. We have talked to the media and begged unions and the nmc for helped. Begged for meetings with the chief executive . When all of those things failed I started this blog back in 2007. th

Claire, I fully admit I am jumping ship for my own sake. I am 23 years old. I have a permanent back condition, mental health issues and a scar from being bitten. All of these things were directly caused by the NHS and there not being enough staff to care for patients. In the case of the biter, I was trying to stop him from falling down a flight of stairs. He wasn't even our patient; I found him in the main corridor. The ward he was on had 1 RN and 1 HCA. He needed a 1:1 nurse, and so did 4 others on that ward. I needed stitches and a tetnus jab in A&E. Patient didn't fall down the stairs, BTW. A nice passer by got security for me.

We can not change the system, as long as the system is being run for profit. I'm sick of being the only HCA for 32 patients, and I can't even lift them up the bed because of my back condition (caused by a lack of manual handling equipment). I can not be in 32 places at once. Nobody can. So if the sole RN asks me to stay with the man on BiPap for 15 minutes whilst she hangs blood on someone else.... then someone is going to sit in their own mess. And a patient on BiPap should have an RN with them at all times, not a HCA, but what is the RN supposed to do?

I'm leaving. For my own sake, yes. I'm too young to feel this old. I'm voting with my feet.

Hell I can tell you more than anyone from being off for the last 6 months from a back condition that we don't have the proper equipment. What did occupational health do? crossed me off my course for 6 months to deal with my "issues" AKA the back pain and emotional upheavel that the NHS is (partly) to blame for. I haven't been paid a penny since I've been off and thats OK apparently for an injury inflicted by placement. I'm just damn lucky I was able to sign-on for a few months and help my dad around the company he works in by doing some paperwork. No support by the NHS or the Uni, jack shit. I'm apprehensive about going back to be honest. Especially when I get tutted and hissed at when I ask a ward sister where the likes of a god damn £12 sliding sheet can be found if there is any. No I won't use the bed sheet. Why? Because the patient weighs TWENTY FIVE stone. Nurse I worked with on first placement absoloutly ruined her back so much she was on a nearby ward for almost 2 weeks and off for god knows long. I wonder how managers sleep at night telling Nurses to put thier health in danger over a measly saving of £12. Oh well, at least the Nurse in question got sick pay, and then some if she has any wits about her she will sue the hospital if she hasn't already.

As for Claire, I would love to know where she works because it is obviously somewhere amazing where she cannot see the failings in the system on each and every ward up and down the land. That or she doesn't work in the NHS at all, which I'm guessing might be the case. Nobody in the NHS on the wards can be incapable of being that ignorant of what is going on around them.

Claire, these ladies here (myself included) want to NURSE, we trained to be Nurses, not saviours of the NHS. We owe nothing to the NHS. Yes they pay my tuition and give me a shitty bursary but I didn't fucking ask for this shit I am being put through with this training. I would pay my tuition and support myself if offered to me. I would be better off. Thanks to the shitty bursary I've been on my arse for the past year and been unable to take out any further loans to support myself by the SLC. I will be jumping ship like alot of people here when I qualify because I have no other choice. I want to have good health and better working conditions, I want to practice my job safely. I want to have a house and a car and get married and have 2.5 children.

I can't do any of that in an NHS job on an NHS wage. Now THAT speaks volumes girl.

Nursing student: When I damaged my back, Occupational health and health and safety said it was my fault for not using a slide sheet. Despite the fact that the management had rationed us at that point to 15 sheets per week on our ward. But it was my fault because I didn't use the equipment.

I and some of the other HCAs on our units would make good nurses. But we will not go and do the training because we see every day what the nurses go through.

Ha Sue you are lucky you have that many. We have none. That is a big fat ZERO. Yet if any member of staff gets hurt lifting a 40 stone patient then it is the member of staffs "fault" for not using the equipment. Hoist is an epic fail as well.

Hoists were normally used on my old ward due to it being stroke but the issue we had were bloody hoist slings... infection control telling us that each patient needs their own hoist sling / slide sheet.

Fine I think, I probably would not want to be hoisted in a sling that was just used on another patient that was incontinent but the wards CANNOT AFFORD TO BUY AMPLE AMOUNTS OF HOIST SLINGS / SLIDE SHEETS FOR EACH AND EVERY PATIENT.

Even if they did have the money then they would much prefer to use the money on something else...

The tubed slide sheets that patients can roll back on were "invented" and patented by a guy (who used to be a nurse & manual handling instructor) who I know through another member of staff at my university. I did meet him briefly at the end of 2009 and I felt like asking him if he knew that his once-affordable creation designed to make the lives of staff and patients easier is now no longer affordable, and the lives of nurses and patients are in danger again. I didn't though. Damn. All I did was comment on how they tickle when pulled out from under you (a student tried it on me in manual handling class).

Now that my back issue is manageable and I will be "allowed back" soon, my first port of call is pre-visit(s) to my next placement. If I see even the slightest hint that they are not using proper manual handling there I will be over to the placement office and occupational health in a shot telling them to stick me in Outpatients, AGAIN.

I can handle working 55hrs a week with travelling etc and getting paid something like £3 per hour for the pleasure (for the first 37.5hours then FOR FREE thereafter). I can handle being used as a dogs body. I can almost handle it being understaffed so long as I don't feel like me being there is a bigger hindrance. However I cannot handle or do any of those things without proper manual handling being used. I won't, either. Not again.

Call me an ungrateful student or whatever. I am in this for a career, I shoulden't have to hand over my health and self-respect at the door. I don't care about this gig THAT much I am fine my health is at risk. I'll just go and be a Biomedical Scientist on the back of my last degree or a photographer and live the bloody simple life.

Having skimmed through the comments below her article, all I can say is that the tories of this country will soon be getting what they think they want- a fully private system...competition and no holds barred asset stripping by the private sector will strip the NHS bare. If you are fit and have a bit of money then you will get a bed in a private hospital for your elective whatever.

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.